Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.
Seattle Cancer Care Alliance, Seattle, WA, USA.
Vox Sang. 2020 May;115(4):334-338. doi: 10.1111/vox.12899. Epub 2020 Feb 20.
D-negative patients are at risk of developing an alloantibody to D (anti-D) if exposed to D during transfusion. The presence of anti-D can lead to haemolytic transfusion reactions and haemolytic disease of the newborn. Anti-D alloimmunization can also complicate allogeneic haematopoietic stem cell transplantation (HSCT) with haemolysis and increased transfusion requirements. The goal of this study was to determine whether cancer centres have transfusion practices intended to prevent anti-D alloimmunization with special attention in patients considered for HSCT.
To understand transfusion practices regarding D-positive platelets in D-negative patients with large transfusion needs, we surveyed the 28 cancer centres that are members of the National Comprehensive Cancer Network (NCCN ).
Nineteen centres responded (68%). Most centres (79%) avoid transfusing D-positive platelets to RhD-negative patients when possible. Four centres (21%) avoid D-positive platelets only in D-negative women of childbearing age. If a D-negative patient receives a D-positive platelet transfusion, 53% of centres would consider treating with Rh immune globulin (RhIg) to prevent alloimmunization in women of childbearing age. Only one centre also gives RhIg to all D-negative patients who are HSCT candidates including adult men and women of no childbearing age.
There is wide variation in platelet transfusion practices for supporting D-negative patients. The majority of centres do not have D-positive platelet transfusion policies focused on preventing anti-D alloimmunization specifically in patients undergoing HSCT. Multicentre, longitudinal studies are needed to understand the clinical implications of anti-D alloimmunization in HSCT patients.
如果 D-阴性患者在输血过程中接触到 D，他们可能会产生针对 D 的同种异体抗体（抗-D）。抗-D 的存在可导致溶血性输血反应和新生儿溶血病。抗-D 同种免疫也可能使异基因造血干细胞移植（HSCT）复杂化，导致溶血和增加输血需求。本研究旨在确定癌症中心是否有预防抗-D 同种免疫的输血实践，特别关注考虑进行 HSCT 的患者。
为了了解针对大量输血需求的 D-阴性患者中 D 阳性血小板的输血实践，我们调查了 National Comprehensive Cancer Network（NCCN）的 28 个癌症中心。
19 个中心（68%）做出了回应。大多数中心（79%）在可能的情况下避免向 RhD 阴性患者输注 D 阳性血小板。4 个中心（21%）仅在生育年龄的 D-阴性女性中避免使用 D 阳性血小板。如果 D-阴性患者接受了 D 阳性血小板输注，53%的中心会考虑使用 Rh 免疫球蛋白（RhIg）治疗，以预防生育年龄女性的同种免疫。只有一个中心也向所有 D-阴性 HSCT 候选患者（包括成年男女，无论是否有生育能力）输注 RhIg。
支持 D-阴性患者的血小板输血实践存在广泛差异。大多数中心没有专门针对 HSCT 患者预防抗-D 同种免疫的 D 阳性血小板输血政策。需要进行多中心、纵向研究，以了解抗-D 同种免疫在 HSCT 患者中的临床意义。
